Myocardial infarction pioglitazone

Overall meta-analysis results by outcome for pioglitazone and rosigUtazone. MACE, major adverse cardiovascular event CV death, cardiovascular death MI, myocardial infarction Serious M. Isch., serious myocardial ischemia Total M. Isch., total myocardial ischenua and... 

Figure 13.3 gives side-by-side forest plots of the results of the two metaanalyses for the placebo-controlled trials for the eight outcomes. For rosiglitazone, the odds ratio estimates were consistently above 1. The 95% confidence interval for myocardial infarction was > 1. For pioglitazone, with... 

Out-patients ( = 39 736) aged 66 years or older who had used either pioglitazone or rosiglitazone were identified from the Ontario Public Drug Benefit Program prescription records [81 ]. Those who had taken pioglitazone had a lower risk of death or hospital admission for either acute myocardial infarction or heart failure compared with rosiglitazone, with an adjusted hazard ratio of 0.8. Further analysis showed that this was due to a reduction in death (adjusted hazard ratio = 0.86) and heart failure (0.77). There was no difference in the risk of acute myocardial infarction (0.95). 

In a case-control study of 9870 cases and 29 610 controls, mean age 63 years, there was difference in the risk of myocardial infarction in those taking pioglitazone compared with rosiglitazone [83 ]. Data were obtained from the Integrated Healthcare Information Services claims database. Cases were defined as people with a diagnosis of myocardial infarction at least 3 months after developing diabetes. 

Systematic reviews In a meta-analysis of five randomized, controlled trials in 9965 patients taking pioglitazone, in which data on myocardial infarction were available, the relative risk of myocardial infarction was 0.86 (95% Cl = 0.69, 1.07) [91 ]. The relative risks for stroke and revascularization were 0.79 (0.61, 1.02) and 0.40 (0.13, 1.23) respectively. The authors concluded that pioglitazone does not increase the risk of myocardial infarction. 

Graham, D.J., Ouellet-Hellstrom, R., MaCurdy, T.E., Ali, F., Sholley, C., Worrall, C., and Kel-man, J.A. 2010. Risk of acute myocardial infarction, stroke, heart failure, and death in elderly Medicare patients treated with rosiglitazone or pioglitazone. JAMA The Journal of the American Medical Association, 304(4), 411-418. 

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